The Apicoectomy / Periradicular Surgery Notes Template
An apicoectomy notes template captures periradicular endodontic surgery — pre-op CBCT review with IAN/sinus proximity assessment, Montgomery consent including paraesthesia and sinus risks, anaesthesia with haemostatic agent, surgical procedure (incision, flap, osteotomy, root-end resection, retrograde cavity, root-end filling), closure with sutures, post-op radiograph, and follow-up — meeting RCS England FDS 2020 and BES 2022 standards.
Apicoectomy notes need to record more risk discussion than any other endodontic procedure — IAN paraesthesia, sinus communication, root fracture all warrant explicit Montgomery consent. Below is the template UK dentists/specialists paste into their PMS.
Download the free Apicoectomy (Periradicular Surgery) template — plain text, GDC/FGDP(UK)-aligned.
Why this apicoectomy (periradicular surgery) template wins
- CBCT justification recorded — IRMER ALARA compliance for the higher-dose modality.
- IAN/sinus proximity assessment per tooth — Montgomery defence for the specific anatomical risk.
- Written consent specifically referenced — for invasive surgical procedures, written consent is best practice and increasingly indemnity-required.
- Tissue sent for histology line — defensible if a cyst or atypia is later discovered.
- Root-end filling lot number — MDR + endodontic traceability.
Compliance: the medico-legal angle
- RCS England FDS Guidelines for Periradicular Surgery (2020) — current UK guidance for the procedure.
- BES Guide to Good Endodontic Practice 2022 — surgical endodontic standards.
- IRMER 2017 — CBCT requires explicit justification beyond 2D alternatives.
- Montgomery — surgical procedures with material nerve risk demand detailed risk-specific consent.
- MDR 2017 — root-end filling material is a regulated medical device; lot number traceability required.
Common mistakes UK dentists make
- CBCT taken without documented justification for dose vs 2D — IRMER breach.
- No specific paraesthesia risk discussion for lower posterior teeth — Montgomery breach.
- Tissue not sent for histology when curettage of soft tissue lesion was performed — leaves no defence if subsequent malignancy diagnosed.
- Antibiotic prescribed routinely post-surgical endo — most cases don't need it; over-prescription is the audit issue.
- No long-term radiographic review scheduled — 1-year and 2-year radiographic healing assessment is the standard.
Frequently asked questions
When is apicoectomy indicated over RCT re-treatment?
When orthograde re-treatment is impossible (e.g. post that can't be removed, transportation, perforation) or has failed. Apicoectomy success after failed re-treatment ~60-70%. Most modern endodontists try re-treatment first if technically feasible — apicoectomy is the second-line option.
When do I need CBCT before apicoectomy?
When 2D imaging doesn't adequately show: root anatomy (curvature, accessory canals), lesion dimensions, neurovascular proximity (IAN, sinus, mental foramen). For most posterior teeth with significant lesions, CBCT is justified. ALARA principle: document why 2D is insufficient.
MTA, bioceramic, or IRM for root-end filling?
MTA and bioceramics (Biodentine, BC RRM) are evidence-based first-line. IRM (zinc oxide eugenol) is historic — still acceptable but bioceramic outperforms in healing studies. Document material and lot number.
How much root-end do I resect?
Modern protocol: 3mm. Older textbooks said 2-3mm with 45° bevel — modern evidence favours 3mm with 0° bevel (perpendicular to long axis) to minimise apical accessory canals left behind.
Do I prescribe antibiotics post-apicoectomy?
Not routinely. SDCEP guidance: antibiotics only when systemic signs, immunocompromised, or significant tissue loss. Most uncomplicated apicoectomies in healthy patients don't need them. Document the rationale either way.
How do I assess success?
Clinical: symptom resolution, sinus tract closure, no tenderness. Radiographic: periapical bone fill on follow-up PA/CBCT at 6, 12, 24 months. Modified Molven criteria — complete / incomplete / uncertain / failure. Document at each review.